Change in perfusion in acute nondominant hemisphere stroke may be better estimated by tests of hemispatial neglect than by the National Institutes of Health Stroke Scale

Background and Purpose - It has been reported that National Institutes of Health Stroke Scale (NIHSS) scores correlate poorly with hypoperfused tissue measured by perfusion-weighted imaging (PWI) in nondominant hemisphere stroke. We conducted 2 studies to determine whether tests of hemispatial neglect provide a better measure of hypoperfusion and reperfusion than NIHSS in nondominant hemisphere stroke. Methods - In study 1, 74 patients with acute ischemic, supratentorial stroke were administered the NIHSS, tests of neglect or aphasia, and diffusion-weighted imaging (DWI) and PWI on day 1 ( < 24 hours from onset) of stroke. Pearson correlations between volumes of PWI/DWI abnormality and functional tests were calculated. In study 2, 10 patients with acute, nondominant hemisphere stroke who were candidates for intervention to restore perfusion underwent PWI, DWI, NIHSS, and a line cancellation test on days 1 and 3. Correlations between change in volumes of PWI/DWI abnormality and change in functional tests were calculated. Results - In study 1, in nondominant hemisphere stroke, volume of PWI abnormality correlated significantly with neglect scores (r = 0.71; P < 0.002) but not with NIHSS scores ( r = 0.39; P = NS). In dominant hemisphere stroke, volume of PWI abnormality correlated better with aphasia scores ( r = 0.50; P = 0.0001) than with NIHSS scores ( r = 0.45; P = 0.001). In study 2, change in volume of hypoperfused tissue on PWI correlated with change in line cancellation performance ( r = 0.83; P = 0.003) but not with change in NIHSS score ( r = 0.26; P = NS). Conclusions - Tests of hemispatial neglect may better reflect dysfunction and reperfusion than NIHSS for patients with nondominant hemisphere stroke.